Correction of Skin Contour Defects in Leaking Stomas by Filler Injection: A Novel Approach for a Difficult Clinical Problem

Abstract

BackgroundStomal leaks can be associated with significant social, psychological and physical morbidity for ostomy patients. Poor fitting of the stoma appliance due to irregularities of skin contours is one cause of stoma leaks which commonly result in secondary irritant dermatitis prompting presentation to a dermatologist. In addition to skin-directed topical therapy and review of stoma appliances, correction of contour defects with intradermal injections of filler materials is one possible treatment to improve adhesion and reduce leaks.CasesWe report eight cases of ostomy patients, who presented with stoma leaks and associated dermatitis, who were treated with intradermal injections of the porcine collagen (Permacol™) or subcutaneous injections of polyacrylamide hydrogel (Aquamid Reconstruction™) for correction of skin contour defects. Resolution or improvement of symptoms was achieved for five patients, and no complications were noted as a result of treatment.ConclusionsThis report represents the largest series of ostomy patients treated for correction of peristomal skin contour defects with injection therapy. Treatment was well tolerated and performed in the outpatient setting under local anesthetic. Attempted correction of peristomal skin contour defects using injection of filler materials represents a potential alternative to surgical intervention and can result in significant benefits for the patient.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0058-x) contains supplementary material, which is available to authorized users.

Modern trends in lipomodeling

“…The use of lipomodeling to correct peristomal soft tissue volume deficiency of an ileostomy has been previously reported and shows some promising results [89], [90]. Lipomodeling improves the peristomal contour, allowing better adhesion of the stoma bag to the abdominal wall.…”

Biocompatible hydrogel ostomy adhesive

“…However, these existing products show relatively weak adhesion strength with limited efficacy to prevent leakages from ostomy bags. Several strategies that utilize the injection of porcine or bovine collagen or synthetic hydrogels into the skin to create improved conformal adhesion of ostomy bags have been proposed (Arai & Okubo, 1999; Smith et al, 2007; Weidmann et al, 2014), but these methods still require complicated application procedures or surgery.…”

Use of Ozone to Treat Ileostomy Dermatitis in an Experimental Rat Model

“…Peristomal irritant dermatitis is the most frequent skin complication and can be both a cause and a consequence of poor adhesion of stoma appliances; it is associated with leakage of stoma contents. This problem is common, affecting up to 62.0% of ostomates, and can be associated with considerable social, psychological, and physical problems [ 3 ]. Irritation of the skin surrounding the stoma is more frequently observed with ileostomies than with colostomies due to greater quantities of liquid and the caustic nature of the bilious small intestinal contents [ 2 ].…”